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What We’re Reading: Unauthorized ACA Plan Switching; Private Equity in Emergency Care; MA Payments Cut
Insurance plan members find themselves involuntarily switched between plans; the Senate investigates patient safety concerns resulting from private equity practices; base payments to Medicare Advantage (MA) plans will decrease in 2025.
ACA Enrollees Encounter Unauthorized Plan Switching
Affordable Care Act (ACA) enrollees are experiencing unauthorized plan-switching disruptions to their coverage, driven by rogue agents exploiting vulnerabilities in federal marketplace security, according to Kaiser Health News. Despite record enrollment, complaints have surged, prompting regulatory actions from CMS, yet the efficacy of these measures remains uncertain. Additionally, brokers have reported ongoing concerns amidst new consent rules, highlighting the urgent need for enhanced safeguards to protect consumers and maintain ACA integrity.
Senate Committee Probes Private-Equity Firms' Impact on ED Care
Senator Gary Peters (D, Michigan) is heading a Senate inquiry into private-equity firms' management of hospital emergency departments, prompted by reports of patient safety and care issues, according to NBC News. Requests for information targeted Apollo Global Management, the Blackstone Group, and KKR, along with affiliated companies, aiming to assess the impact of private-equity practices on health care quality and physician autonomy. As private-equity firms increasingly dominate the health care sector, concerns continue to mount over cost-saving measures that potentially compromise patient safety, which have prompted calls for transparency and accountability from industry stakeholders.
Biden Administration Cuts MA Payments
The Biden administration's decision to reduce base payments to Medicare Advantage (MA) plans by an average of 0.16% has triggered a market downturn for major insurers like UnitedHealth, CVS Health, Humana, and Centene, amidst fears of ongoing financial challenges, according to Axios. While risk-adjusted payments may mitigate the impact, insurers expressed worries over continued pressure on seniors' benefits and potential benefit reductions due to rising costs and policy changes. With MA enrollment surging, concerns persist over overpayment and cost escalation.
Stuck in Prior Auth Purgatory: The Hidden Costs of Health Care Delays
June 19th 2025Delays, denials, and endless paperwork—prior authorization isn’t just a headache for providers; it’s a barrier for patients who need timely care, explains Colin Banas, MD, MHA, chief medical officer with DrFirst.
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From Red Tape to Relief: Rewriting the Rules of Prior Authorization
June 23rd 2025Up to 257 million Americans could benefit from these prior authorization reforms that could have cross-market implications on health care plans administered through commercial insurers, Medicare Advantage, and Medicaid.
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10 Years of Coverage Gains Threatened by Proposed Federal Policy Changes, Report Finds
June 18th 2025The country has seen historic reductions in uninsured rates and improvements in affordability since the implementation of the Affordable Care Act, the Commonwealth Fund scorecard shows.
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